What is included
The full cycle as standard. Take all of it, or start with a single piece such as AR recovery.
Pricing
Billing is priced on what we collect for you, which keeps our incentive pointed the same way as yours. Send us your volume and specialty and we will confirm the rate in writing.
- Claim submission and scrubbing
- Denial and rejection management
- Accounts receivable follow-up
- Prior authorization support
- Payment posting and reconciliation
- Financial reporting and performance tracking
- Insurance verification and eligibility checks
- Charge entry and medical coding
- Patient billing and statement support
- Appeal preparation and submission
The cycle, stage by stage
Every claim runs the same route. The difference is whether anyone is watching it.
Insurance verification
Eligibility confirmed before the encounter. Verifying up front is the cheapest denial you will ever prevent.
Medical coding and charge entry
Diagnoses, procedures and services translated into the standardized codes payers accept. Accuracy here decides everything downstream.
Claim submission and scrubbing
Claims checked before they go out, so nothing is lost to a missing modifier or a formatting error.
Payer follow-up
Status tracked and payers contacted directly. When a claim stalls we know in days, not at month end.
Payment posting and reconciliation
Payments recorded against the right encounter, with discrepancies surfaced immediately.
Denial and rejection management
Denials analyzed for root cause, corrected and appealed — and the pattern fed back upstream so the same denial stops recurring.
Accounts receivable follow-up
Persistent pursuit of everything outstanding. This is the unglamorous work that keeps days in AR under thirty.
Financial reporting
Daily charges and payments, the key performance markers, and a plain read on what needs fixing at your end.
Medicare and Medicaid, handled properly
Every state writes its own Medicaid filing rules and reimbursement requirements, and they change. We stay current on them, apply the right forms and codes the first time, then monitor each claim through to payment.
- State-by-state Medicaid filing rules tracked and applied
- Medicare claims monitored through adjudication
- Appeals prepared and filed on underpayments and denials
- Documentation guidance so recurring denials stop recurring
Payers and systems we work in every day
We bill in your practice management system, not ours, and we already know the portals, edits and timely-filing rules of the payers below. If yours is not listed, ask — it almost certainly is.
Payers
- Medicare
- Medicaid and state MCOs
- Aetna
- Anthem / Blue Cross Blue Shield
- Cigna
- UnitedHealthcare
- Humana
- Oscar
- EmblemHealth
- Healthfirst
- Fidelis Care
- MetroPlusHealth
- MVP Health Care
- Tricare
- Workers' compensation
- No-fault
Practice management and EHR systems
- Tebra (Kareo)
- AdvancedMD
- athenahealth
- eClinicalWorks
- DrChrono
- Practice Fusion
- NextGen
- Office Ally
- TherapyNotes
- SimplePractice
- Epic
- Oracle Health (Cerner)
- Allscripts / Veradigm
- CareCloud
- ModMed
- WebPT
In-house billing versus Core MB
The honest comparison most practices run in their heads before they call us.
| Billing in-house | Billing with Core MB | |
|---|---|---|
| Coverage | One or two people; claims stop when someone is out sick or leaves. | A team, with a named account manager and no gaps for vacations or turnover. |
| Specialty knowledge | Whatever the biller has seen before. | A team assigned by specialty that already knows your payers' rules and favorite denials. |
| Payer follow-up | When there is time, usually at month end. | Every open claim worked on a fixed cadence; stalls caught in days. |
| Denials | Reworked one at a time, often written off. | Root cause found, fixed upstream, appealed where warranted. |
| Software and clearinghouse | Licenses, updates, training and clearinghouse fees on you. | Included. We work in your system or bring ours. |
| Cost structure | Salary, benefits, software and training whether or not claims get paid. | A share of what we collect, so our incentive points the same way as yours. |
| Adding providers | More staff, more training, more desks. | Credentialing and billing scale together, tracked in your client portal. |
| Reporting | Whatever the system exports. | A monthly read on charges, payments, denials and AR you can act on. |
Billing questions
What does a medical billing company actually do for my practice?
We take over the logistical work of getting you paid. That means coding the encounter, filing the claim, chasing the payer, posting the payment and following up on anything that stalls. Practices that outsource billing typically see lower overhead, steadier cash flow, fewer denials, and a front office that can spend its time on patients rather than invoices.
Which billing services are included?
Provider enrollment, insurance verification, charge entry, claim submission, payment posting, accounts receivable management, denial management, appeal management, patient billing, reimbursement tracking and collections. Most clients take the full cycle, but you can start with a single piece such as AR recovery or credentialing.
How do you handle denials and underpayments?
Submitting a clean claim is only the first step. Once a claim is filed we own it — we speak to payers directly, track status daily, and act as soon as something stalls. Underpaid and denied claims go into a persistent follow-up cycle with appeals filed where they are warranted, so your practice recovers what it is owed rather than writing it off.
Can I see how my billing is performing?
Yes. You get reporting on daily charges and payments, the key performance markers for your revenue cycle, and a plain-language read on what is working and what needs attention. Nothing is hidden behind a portal you have to interpret alone.
Do you work with Medicare and Medicaid claims?
We do. Every state sets its own filing rules and reimbursement requirements for Medicaid, and Medicare has its own moving parts. We stay current on both, apply the right forms and codes the first time, monitor each claim through adjudication, and handle appeals when they are needed.
How do we switch from our current billing company?
Without a gap. We start by running in parallel: your current biller finishes the claims already in flight while we take over new charges from an agreed date, and we pick up the open AR they leave behind. You keep your practice management system; we work in it. Most transitions are fully handed over within a month.
What is the difference between medical billing and revenue cycle management?
Medical billing is the claim: coding, submission, posting and follow-up. Revenue cycle management covers everything that affects whether you get paid, from credentialing and eligibility before the visit to denial prevention, patient balances and reporting after it. We offer both, and most clients take the full cycle.
Do you work in our practice management system?
Yes. We bill inside the system you already use, so your records, reports and patient balances stay in one place. If you are starting from scratch we will recommend one that fits your specialty and volume.
Find out what you are leaving on the table
Send us a snapshot of your current billing and we will come back with a quote and a realistic view of recoverable revenue.